Oral leukoplakia: A clinicopathological study and malignant transformation.

OBJECTIVES: To assess the clinicopathological characteristics of a cohort of patients with oral leukoplakia (OL) managed in a Romanian dental hospital and to evaluate the risk of malignant transformation (MT). MATERIALS AND METHODS: We conducted a hospital-based retrospective study using the clinical charts of patients diagnosed with OL that had complete clinical and histopathological evaluation followed up for 1-16 years. RESULTS: From 120 included patients, 68 (56.7%) were females, and 71 (59.2%) were current smokers. The homogeneous form was present in 60% of cases; the buccal mucosa was the most frequently involved site. MT was observed in 9 cases, which was more common in females and in those with dysplastic leukoplakia. A significant statistical association was found between MT and dysplasia grade (χ2 test: p = 0.007). MT occurred during a mean interval of time 75 months in both treated and non-treated patients. CONCLUSIONS: In this leukoplakia cohort, most of the lesions encountered were in smokers, clinically homogeneous and 62.5% proved histologically benign. But despite the clinically benign appearance of leukoplakia, tissue diagnosis of some cases was carcinoma. The results of the current study advocate the necessity for biopsy even in apparently homogeneous, clinically benign lesions. The malignization rate was 7.5%; two-thirds were nonhomogeneous lesions.

Saliva--a diagnostic window to the body, both in health and in disease.

Saliva, the most available and non-invasive biofluid of the human body, permanently "bathes" the oral cavity and is trying to cope with an ever-changing milieu. The oral cavity, a very complex and unique milieu due to its dual function, is the only place in the body where the mineralized tissue is exposed to the external environment in which there are complex interactions between various surfaces: host soft and hard tissues, food, air, and microorganisms. Saliva includes a large number of inorganic and organic compounds, which act as a "mirror of the body's health." In addition to its other functions, saliva could constitute the first line of defense against oxidative stress. Due to its composition and functions, saliva could have a significant role in controlling and/or modulating oxidative damages in the oral cavity. As a diagnostic fluid, saliva offers distinctive advantages over serum. Furthermore, saliva may provide a cost-effective approach for the screening of large populations. Gland-specific saliva can be used for diagnosis of pathology specific to one of the major salivary glands. Whole saliva, however, is most frequently used for diagnosis of systemic diseases. As we enter the era of genomic medicine, sialochemistry will play an increasingly important role in the early detection, the monitoring and progression of the systemic and oral diseases. We reviewed the current data within literature and of our research concerning clinical potential of the saliva.

Cigarette smoke effect on total salivary antioxidant capacity, salivary glutathione peroxidase and gamma-glutamyltransferase activity.

Saliva is the first biological fluid that inhaled cigarette smoke (CS) encounters. CS contains several carcinogens known to initiate and promote tumourigenesis and metastasis. One of the aims of this study was to establish if glutathione peroxidase and gamma-glutamyltranspherase (GGT) could be used as possible markers for evaluating the oral oxidative stress caused by smoking. The effect of CS on free radical generation was investigated using two methods. Using different assays, different antioxidants present in saliva may be evidenced due to the different principles on which they are based. Our results indicate that exposure to CS caused a statistically significant decrease of both salivary glutathione peroxidase (p < 0.01) and salivary GGT (p < 0.01). We also found that exposure to CS caused a statistically significant decrease of salivary total antioxidant status (p < 0.01). Such decreases may have a consistent role in the mechanisms by which the toxic effects of CS initiate oral inflammatory diseases, promote precancerous transformations, and destroy the oral cavity homeostasis. Therefore the evaluation of total antioxidant capacity of saliva is important but it must be done together with the evaluation of salivary specific markers of oxidative stress, such as uric acid, albumin and possibly, GGT.

Effect of gas phase and particulate phase of cigarette smoke on salivary antioxidants. What can be the role of vitamin C and pyridoxine?

The effect of smoking is in our days a serious global public health problem of major concern. Incidence of oral squamous cell carcinoma (SCC) in cigarette smokers is four to seven times higher than in nonsmokers. There is a constant and direct attack of various cigarette smoke constituents on the oral epithelial cells, which gradually accumulate and cause malignant transformation. Saliva is the first biological fluid that encounters inhaled cigarette smoke (CS). We have studied the influence of CS on salivary antioxidant capacity, uric acid, amylase and LDH (lactate dehydrogenase). In our study both, gas and particulate phase of CS were tested separately, and possible antioxidant effect of pyridoxine on salivary components was examined. Our results indicate that exposure to both, gas and particulate phase of CS caused a statistically significant decrease in salivary uric acid, LDH and amylase activity. We have also studied the effect of vitamin C (10 mg/dl) and vitamin B6 (1 mM) during incubation of saliva in the presence of CS. The addition of vitamin C had a significant (p < 0.05) protective effect on salivary uric acid level (0.25 +/- 0.12 for saliva incubated with gas phase of CS vs. 0.65 +/- 0.12 for saliva incubated with gas phase of CS in the presence of vitamin C). Vitamin C was not able to maintain/restore the original uric acid level. In the presence of the gas phase, pyridoxine had no protective effect, neither on salivary uric acid level nor on the FRAP activity of saliva. The purpose of our study was to discover a connection between the level of antioxidants in saliva in the presence of the two components of CS. Our results show that salivary antioxidant system is significantly and distinctly affected by both gas and particulate phase of CS and suggest that an adequate intake of antioxidants may help smokers to avoid CS-induced oxidative damage and to prevent degenerative diseases.

Salivary aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase: possible markers in periodontal diseases?

BACKGROUND: Saliva can be used as a diagnostic fluid in medicine. Components of saliva proposed as disease markers include enzymes (alkaline phosphatase, esterase, glucuronidase, aminopeptidase), immunoglobulins (IgA, IgG), and hormones (steroid hormones). Many of these salivary components appeared to be useful biochemical markers of the evolution of periodontal disease, for which salivary analysis can offer a cost-effective approach for monitoring the disease. The salivary components proposed as markers for periodontal disease activity are aspartate aminotransferase (AST), alkaline phosphatase (ALP), aminopeptidases, and glucuronidases. The purpose of our study was to illustrate the influence of periodontal disease on the level of salivary AST, alanine aminotransferase (ALT) and ALP. METHODS: All clinical periodontal examinations were performed by the same periodontist. All patients included in the study presented a probing depth >5 mm, bleeding on probing and alveolar bone loss >40%. Salivary AST, ALT and ALP activities were measured using DiaSys analysis kits from Diagnostic Systems. The methods were adapted for saliva. RESULTS: Salivary AST activity in patients with periodontal disease was significantly increased (p<0.01) (median 81.75+/-23 U/L) compared with controls (15.25+/-10.5 U/L). Salivary ALT activity was not significantly modified in saliva from patients with periodontal disease compared with the control group. Our results showed a significant (p<0.01) increase in salivary ALP activity (34.38+/-1.5 U/L) in patients with periodontal disease compared with controls (6.6+/-4.2 U/L). CONCLUSIONS: Our results revealed that periodontal destruction such as periodontal pockets, gingival bleeding and suppuration are related to higher ALP and AST levels in saliva. Salivary AST could be used as a useful marker for monitoring periodontal disease. The increase in salivary ALP activity in periodontitis demonstrated could be associated with alveolar bone loss, a key feature of periodontal disease. More studies are necessary to evaluate which specific clinical, microbiological and histological characteristics of periodontal disease are associated with elevated levels of AST and ALP in saliva.